Abbarh Shahem, Sawaf Bisher, Almasri Hussam, Balaraju Girisha, Albuni Mhd Kutaiba, Abbarah Shaher, Ahmed Ashraf I, Ismail Abdellatif, Al Kaabi Saad Rashid Mohammad
Department of Internal Medicine Hamad Medical Corporation Doha Qatar.
Department of Internal Medicine University of North Dakota Fargo North Dakota USA.
Clin Case Rep. 2024 Oct 31;12(11):e9378. doi: 10.1002/ccr3.9378. eCollection 2024 Nov.
It is important to consider the diagnosis of Sump syndrome in patients with a history of open cholecystectomy, particularly in those who migrate from developing countries where alternative biliary interventions may be limited. The presentation may range from acute severe, mimicking acute ascending cholangitis, to chronic recurrent abdominal pain without evidence of inflammation. Management is a case-by-case decision, with principal management aims to decompress the biliary tract and address any underlying sepsis.
Sump syndrome is a rare and often long-term complication of choledochoduodenostomy (CDD). The presentation and severity are variable, and management should be tailored to each patient based on several factors. Herein, we report three cases of sump syndrome, each demonstrating unique diagnostic dilemmas and therapeutic modalities. Case I describes a woman presenting with acute cholangitis, managed with percutaneous transhepatic cholangiography (PTC) and endoscopic retrograde cholangiopancreatography (ERCP). Case II illustrates a similar presentation complicated by myocardial infarction, necessitating urgent biliary decompression via PTC and subsequent unsuccessful endoscopic stenting. Case III highlights the diagnostic difficulty in a stable patient with inconclusive diagnostic imaging. This case series emphasizes the importance of considering sump syndrome diagnosis in patients with a history of CDD or open cholecystectomy, especially in elderly patients and those who come from regions where alternative biliary interventions may be limited.
对于有开腹胆囊切除术病史的患者，尤其是那些从发展中国家移民而来且可能缺乏其他胆道干预手段的患者，考虑胆总管十二指肠吻合口综合征（Sump综合征）的诊断非常重要。其表现范围广泛，从酷似急性化脓性胆管炎的急性重症表现，到无炎症证据的慢性复发性腹痛。治疗需根据具体情况决定，主要治疗目标是胆道减压并处理任何潜在的脓毒症。
Sump综合征是胆总管十二指肠吻合术（CDD）一种罕见且常为长期的并发症。其表现和严重程度各不相同，治疗应根据多个因素为每个患者量身定制。在此，我们报告三例Sump综合征病例，每例都展示了独特的诊断难题和治疗方式。病例一描述了一名出现急性胆管炎的女性，通过经皮肝穿刺胆管造影术（PTC）和内镜逆行胰胆管造影术（ERCP）进行治疗。病例二说明了类似表现并发心肌梗死，需要通过PTC紧急胆道减压以及随后内镜支架置入未成功的情况。病例三突出了在诊断成像结果不明确的稳定患者中的诊断困难。该病例系列强调了在有CDD病史或开腹胆囊切除术病史的患者中，尤其是老年患者以及来自替代胆道干预手段可能有限地区的患者中，考虑Sump综合征诊断的重要性。
